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Journal of Endovascular Therapy : An... Jun 2010Vascular surgery has been widely practiced in hospitals within a general surgical service, although the consequent workload of individual vascular units has been small.... (Review)
Review
Vascular surgery has been widely practiced in hospitals within a general surgical service, although the consequent workload of individual vascular units has been small. There is an increasing body of evidence in favor of a positive relationship between hospital and surgeon volumes and the outcome of arterial surgery. These relationships suggest that vascular surgical procedures might be best placed within a centralized model of care to increase volume and thereby attain best outcomes. This systematic review appraises the current evidence for volume-outcome relationships in vascular surgery from a number of healthcare systems to examine the basis for centralization of vascular surgical services. The index procedures addressed in this review are open or endovascular repair of abdominal aortic aneurysm (AAA), ruptured AAA, descending thoracic aortic aneurysm, and thoracoabdominal aortic aneurysm, along with carotid endarterectomy and lower extremity arterial bypass.
Topics: Aortic Aneurysm; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Aortic Rupture; Arterial Occlusive Diseases; Carotid Artery Diseases; Centralized Hospital Services; Clinical Competence; Constriction, Pathologic; Endarterectomy, Carotid; Hospitals; Humans; Lower Extremity; Outcome and Process Assessment, Health Care; Quality Indicators, Health Care; Risk Assessment; Risk Factors; Treatment Outcome; Vascular Surgical Procedures; Workload
PubMed: 20557176
DOI: 10.1583/10-3035.1 -
Pediatric Nephrology (Berlin, Germany) Feb 2016Hematuria secondary to renal vein entrapment is mentioned only passing in textbooks and reviews. (Review)
Review
BACKGROUND
Hematuria secondary to renal vein entrapment is mentioned only passing in textbooks and reviews.
METHODS
We performed a search of the National Library of Medicine database for peer-reviewed publications using the terms "renal vein" or "nutcracker" and "hematuria".
RESULTS
We identified 187 published reports/studies that covered 736 patients, of whom 288 had microscopic hematuria and 448 had macroscopic hematuria. The patient cohort comprised 159 patients aged ≤17 years. Abdominal pain was absent in approximately 65% of all patients, and a clinically relevant left-sided varicocele was observed in 29% of the male patients. A normal pre-aortic left renal vein and an anomalous anatomy were noted in 680 and 56 patients, respectively. The body mass index (BMI) was lower in patients with renal vein entrapment than in the controls, with a regression of hematuria correlating with an increase in BMI. A surgical procedure was attempted in 34% of the patients, of which the most common were endovascular stenting and transposition of the renal vein distally into the vena cava.
CONCLUSIONS
In cases of unexplained hematuria with or without abdominal pain, clinicians should consider the diagnosis of renal vein congestion, especially in males with varicocele. Ultrasonic Doppler flow scanning is the recommended initial diagnostic modality in these patients. Expectation management is advised in the great majority of cases.
Topics: Adolescent; Adult; Child; Constriction, Pathologic; Female; Hematuria; Humans; Male; Renal Nutcracker Syndrome; Renal Veins; Young Adult
PubMed: 25627663
DOI: 10.1007/s00467-015-3045-2 -
Journal of Clinical Medicine Jan 2024A growing body of evidence suggests that extrathoracic vascular accesses for transcatheter aortic valve replacement (TAVR) yield favorable outcomes and can be considered... (Review)
Review
A growing body of evidence suggests that extrathoracic vascular accesses for transcatheter aortic valve replacement (TAVR) yield favorable outcomes and can be considered as primary alternatives when the gold-standard transfemoral access is contraindicated. Data comparing the transcaval (TCv) to supra-aortic (SAo) approaches (transcarotid, transsubclavian, and transaxillary) for TAVR are lacking. We aimed to compare the outcomes and safety of TCv and SAo accesses for TAVR as alternatives to transfemoral TAVR. A systematic review with meta-analysis was performed by searching PubMed/MEDLINE and EMBASE databases for all articles comparing TCv-TAVR against SAo-TAVR published until September 2023. Outcomes included in-hospital or 30-day all-cause mortality (ACM) and postoperative complications. A total of three studies with 318 TCv-TAVR and 179 SAo-TAVR patients were included. No statistically significant difference was found regarding in-hospital or 30-day ACM (relative risk [RR] 1.04, 95% confidence interval [CI] 0.47-2.34, = 0.91), major bleeding, the need for blood transfusions, major vascular complications, and acute kidney injury. TCv-TAVR was associated with a non-statistically significant lower rate of neurovascular complications (RR 0.39, 95%CI 0.14-1.09, = 0.07). These results suggest that both approaches may be considered as first-line alternatives to transfemoral TAVR, depending on local expertise and patients' anatomy. Additional data from long-term cohort studies are needed.
PubMed: 38256589
DOI: 10.3390/jcm13020455 -
Journal of Science and Medicine in Sport Jan 2016To examine whether differences in arterial diameter exist between athletes participating in endurance, resistance or mixed exercise training. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To examine whether differences in arterial diameter exist between athletes participating in endurance, resistance or mixed exercise training.
DESIGN
A systematic review with meta-analysis.
METHODS
Random effects meta-analyses of the weighted mean difference in aortic, carotid, brachial and femoral arterial diameters, height and body mass were conducted on data from 16 peer-reviewed studies indexed on PubMed, MEDLINE, SCOPUS and Sport Discus. Effect sizes were calculated as the standardised difference in means (δ), and used to compare endurance (n=163), resistance (n=192), and mixed trained athletes (n=360), with controls (n=440).
RESULTS
Compared to controls, endurance athletes displayed the greatest difference in diameter in the brachial artery (δ=1.84, 95% CI: 0.59, 3.09, p<0.01), whereas for mixed athletes, the greatest difference in diameter occurred in the femoral artery (δ=3.65, 95% CI: 2.21, 5.10, p<0.01), despite there being no differences in height or body mass between these groups. Resistance athletes had a significantly greater body mass (p=0.047) and aortic diameter (δ=1.81, 95% CI: 1.58, 2.05, p<0.01) than controls, however differences in other vessels could not be determined through meta-analysis due to insufficient data.
CONCLUSIONS
Our results provide evidence for localised arterial differences, which occur more extensively in peripheral vessels (brachial and femoral). Chronically, vascular remodelling may occur as a result of the specific haemodynamic conditions within each vessel, which likely differs depending on the mode of exercise. In the future, empirical research is needed to understand the effect of resistance training on chronic vascular remodelling, as this is not well documented.
Topics: Adaptation, Physiological; Arteries; Humans; Physical Conditioning, Human; Physical Endurance; Resistance Training; Vascular Remodeling
PubMed: 25579977
DOI: 10.1016/j.jsams.2014.12.007 -
Future Cardiology Mar 2022The impact on safety and efficacy outcomes of Impella 5.0 in cardiogenic shock (CS) has not been systematically assessed. We conducted a systematic review of the... (Review)
Review
The impact on safety and efficacy outcomes of Impella 5.0 in cardiogenic shock (CS) has not been systematically assessed. We conducted a systematic review of the literature (PROSPERO protocol: CRD42020164680) to critically appraise available evidence on Impella 5.0 comparative safety, efficacy and effectiveness. Of 244 retrieved citations, 17 original articles met the defined inclusion criteria. All included studies had a retrospective study design and, overall, reported on, respectively, 52 and 67 different safety and efficacy/effectiveness outcomes. Thirty-day survival rates ranged from 40 to 94%, myocardial recovery from 18 to 93%. Impella 5.0 provides a full cardiac support, it is associated with a lower rate of vascular complications, it represents a valuable bridge-to-decision and allows for resolution of intercurrent clinical conditions. As available data suggest Impella 5.0 good performance in CS of various etiologies, more solid evidence will come from much-needed large-scale all-comer registries and prospective multicenter randomized trials.
Topics: Heart-Assist Devices; Humans; Multicenter Studies as Topic; Prospective Studies; Registries; Retrospective Studies; Shock, Cardiogenic; Treatment Outcome
PubMed: 34713720
DOI: 10.2217/fca-2021-0046 -
International Journal of Cardiology Nov 2016Proximal aorta stiffens and dilates with aging. Aortic stiffening is a well known process, carrying prognostic implications. On the contrary, few data are available... (Review)
Review
INTRODUCTION
Proximal aorta stiffens and dilates with aging. Aortic stiffening is a well known process, carrying prognostic implications. On the contrary, few data are available about proximal aorta dilatation. It is not known if "out of proportion" aortic remodeling, i.e. in excess for age, sex and body size, could be a marker of early vascular ageing; there is controversy on how it would be accelerated by classical risk factors or would associate with validated markers of cardiovascular organ damage.
AIM
We conducted a systematic review in order to evaluate the determinants of proximal aortic dimensions, focusing on the association with arterial hypertension, cardiovascular risk factors and markers of organ damage.
DETERMINANTS OF PROXIMAL AORTA REMODELING
Age, gender and body size explain 40-50% of the variability of aortic dimensions; genetic predisposition accounts for nearly 20%. Among cardiovascular risk factors obesity and hypertension seem to be associated with faster outward aortic remodeling. Arterial hypertension would account for a 0.60-0.78 mm greater diameter at the ascending aorta. Moreover, in hypertension, left ventricular mass showed a strict association with aortic diameter in nearly all studies. Other classical risk factors for atherogenesis such as dyslipidemia and smoking showed a weak influence on proximal aortic dimensions. No study reported a greater aortic remodeling in diabetics.
CONCLUSIONS
"Out of proportion" proximal aortic remodeling, could represent a subclinical marker of early vascular ageing, describing the cumulative influence of genetic predisposition, arterial hypertension and obesity.
Topics: Aging; Aorta, Thoracic; Cardiovascular Diseases; Humans; Organ Size; Risk Factors; Vascular Remodeling; Vascular Stiffness
PubMed: 27591699
DOI: 10.1016/j.ijcard.2016.07.302 -
PeerJ 2024Obesity is a well-known predictor for poor postoperative outcomes of vascular surgery. However, the association between obesity and outcomes of thoracic endovascular... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Obesity is a well-known predictor for poor postoperative outcomes of vascular surgery. However, the association between obesity and outcomes of thoracic endovascular aortic repair (TEVAR) is still unclear. This systematic review and meta-analysis was performed to assess the roles of obesity in the outcomes of TEVAR.
METHODS
We systematically searched the Web of Science and PubMed databases to obtain articles regarding obesity and TEVAR that were published before July 2023. The odds ratio (OR) or hazard ratio (HR) was used to assess the effect of obesity on TEVAR outcomes. Body mass index (BMI) was also compared between patients experiencing adverse events after TEVAR and those not experiencing adverse events. The Newcastle-Ottawa Scale was used to evaluate the quality of the enrolled studies.
RESULTS
A total of 7,849 patients from 10 studies were included. All enrolled studies were high-quality. Overall, the risk of overall mortality (OR = 1.49, 95% CI [1.02-2.17], = 0.04) was increased in obese patients receiving TEVAR. However, the associations between obesity and overall complications (OR = 2.41, 95% CI [0.84-6.93], = 0.10) and specific complications were all insignificant, including stroke (OR = 1.39, 95% CI [0.56-3.45], = 0.48), spinal ischemia (OR = 0.97, 95% CI [0.64-1.47], = 0.89), neurological complications (OR = 0.13, 95% CI [0.01-2.37], = 0.17), endoleaks (OR = 1.02, 95% CI [0.46-2.29], = 0.96), wound complications (OR = 0.91, 95% CI [0.28-2.96], = 0.88), and renal failure (OR = 2.98, 95% CI [0.92-9.69], = 0.07). In addition, the patients who suffered from postoperative overall complications ( < 0.001) and acute kidney injury ( = 0.006) were found to have a higher BMI. In conclusion, obesity is closely associated with higher risk of mortality after TEVAR. However, TEVAR may still be suitable for obese patients. Physicians should pay more attention to the perioperative management of obese patients.
Topics: Humans; Obesity; Endovascular Procedures; Postoperative Complications; Aorta, Thoracic; Body Mass Index; Risk Factors; Treatment Outcome; Endovascular Aneurysm Repair
PubMed: 38650653
DOI: 10.7717/peerj.17246 -
The Cochrane Database of Systematic... Nov 2017Marfan syndrome is a hereditary disorder affecting the connective tissue and is caused by a mutation of the fibrillin-1 (FBN1) gene. It affects multiple systems of the... (Review)
Review
BACKGROUND
Marfan syndrome is a hereditary disorder affecting the connective tissue and is caused by a mutation of the fibrillin-1 (FBN1) gene. It affects multiple systems of the body, most notably the cardiovascular, ocular, skeletal, dural and pulmonary systems. Aortic root dilatation is the most frequent cardiovascular manifestation and its complications, including aortic regurgitation, dissection and rupture are the main cause of morbidity and mortality.
OBJECTIVES
To assess the long-term efficacy and safety of beta-blocker therapy as compared to placebo, no treatment or surveillance only in people with Marfan syndrome.
SEARCH METHODS
We searched the following databases on 28 June 2017; CENTRAL, MEDLINE, Embase, Science Citation Index Expanded and the Conference Proceeding Citation Index - Science in the Web of Science Core Collection. We also searched the Online Metabolic and Molecular Bases of Inherited Disease (OMMBID), ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 30 June 2017. We did not impose any restriction on language of publication.
SELECTION CRITERIA
All randomised controlled trials (RCTs) of at least one year in duration assessing the effects of beta-blocker monotherapy compared with placebo, no treatment or surveillance only, in people of all ages with a confirmed diagnosis of Marfan syndrome were eligible for inclusion.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened titles and abstracts for inclusion, extracted data and assessed trial quality. Trial authors were contacted to obtain missing data. Dichotomous outcomes will be reported as relative risk and continuous outcomes as mean differences with 95% confidence intervals. We assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
MAIN RESULTS
One open-label, randomised, single-centre trial including 70 participants with Marfan syndrome (aged 12 to 50 years old) met the inclusion criteria. Participants were randomly assigned to propranolol (N = 32) or no treatment (N = 38) for an average duration of 9.3 years in the control group and 10.7 years in the treatment group. The initial dose of propranolol was 10 mg four times daily and the optimal dose was reached when the heart rate remained below 100 beats per minute during exercise or the systolic time interval increased by 30%. The mean (± standard error (SE)) optimal dose of propranolol was 212 ± 68 mg given in four divided doses daily.Beta-blocker therapy did not reduce the incidence of all-cause mortality (RR 0.24, 95% CI 0.01 to 4.75; participants = 70; low-quality evidence). Mortality attributed to Marfan syndrome was not reported. Non-fatal serious adverse events were also not reported. However, study authors report on pre-defined, non-fatal clinical endpoints, which include aortic dissection, aortic regurgitation, cardiovascular surgery and congestive heart failure. Their analysis showed no difference between the treatment and control groups in these outcomes (RR 0.79, 95% CI 0.37 to 1.69; participants = 70; low-quality evidence).Beta-blocker therapy did not reduce the incidence of aortic dissection (RR 0.59, 95% CI 0.12 to 3.03), aortic regurgitation (RR 1.19, 95% CI 0.18 to 7.96), congestive heart failure (RR 1.19, 95% CI 0.18 to 7.96) or cardiovascular surgery, (RR 0.59, 95% CI 0.12 to 3.03); participants = 70; low-quality evidence.The study reports a reduced rate of aortic dilatation measured by M-mode echocardiography in the treatment group (aortic ratio mean slope: 0.084 (control) vs 0.023 (treatment), P < 0.001). The change in systolic and diastolic blood pressure, total adverse events and withdrawal due to adverse events were not reported in the treatment or control group at study end point.We judged this study to be at high risk of selection (allocation concealment) bias, performance bias, detection bias, attrition bias and selective reporting bias. The overall quality of evidence was low. We do not know whether a statistically significant reduced rate of aortic dilatation translates into clinical benefit in terms of aortic dissection or mortality.
AUTHORS' CONCLUSIONS
Based on only one, low-quality RCT comparing long-term propranolol to no treatment in people with Marfan syndrome, we could draw no definitive conclusions for clinical practice. High-quality, randomised trials are needed to evaluate the long-term efficacy of beta-blocker treatment in people with Marfan syndrome. Future trials should report on all clinically relevant end points and adverse events to evaluate benefit versus harm of therapy.
Topics: Adolescent; Adrenergic beta-Antagonists; Adult; Aortic Dissection; Humans; Marfan Syndrome; Middle Aged; Propranolol; Young Adult
PubMed: 29110304
DOI: 10.1002/14651858.CD011103.pub2 -
Atherosclerosis Feb 2013The importance of obesity as a risk factor for atherothrombosis has been clearly demonstrated. Abdominal aortic aneurysm (AAA) is believed to develop due to mechanisms... (Review)
Review
OBJECTIVES
The importance of obesity as a risk factor for atherothrombosis has been clearly demonstrated. Abdominal aortic aneurysm (AAA) is believed to develop due to mechanisms distinct from atherosclerosis. The aim of this systematic review was to critically assess published evidence examining: (1) the association of obesity with AAA presence; (2) the association of obesity with AAA growth.
METHODS
Studies investigating the association of markers of obesity with AAA were identified by searching the PUBMED database and hand searching of article reference lists. To be eligible for inclusion studies had to report a recognised measure of adiposity, i.e. body mass index, waist circumference or an imaging technique to quantify adipose distribution. AAA presence and progression also had to be reported and assessed by ultrasound or computed tomography. Eight eligible studies assessed the association of obesity with AAA presence; and two studies which assessed the association of obesity with AAA growth were included.
RESULTS
Of the eight studies that examined AAA presence, five studies examined body mass index (BMI) and three studies measured waist circumference (WC). Three of five studies reported that BMI was positively associated with AAA presence or increasing abdominal aortic diameter. Two of three studies reported that WC was positively associated with AAA presence or larger abdominal aortic diameter. Three of the included studies utilised secondary measures of adiposity: waist-to-hip ratio (WHR), ultrasound assessment of adiposity and bioimpedence testing. Of these, only WHR was found to have a significant positive association with AAA presence. Of the two studies assessing the association of obesity with AAA growth both reported no association between BMI and AAA progression.
CONCLUSION
The reviewed studies suggest that anthropometric measures of BMI and WC are associated with AAA presence. Currently there is no convincing data that obesity is associated with AAA growth but further studies employing more detailed anthropometric measures are needed.
Topics: Adipose Tissue; Adiposity; Aged; Analysis of Variance; Aortic Aneurysm, Abdominal; Body Mass Index; Female; Humans; Male; Middle Aged; Obesity; Tomography, X-Ray Computed; Ultrasonography; Waist Circumference; Waist-Hip Ratio
PubMed: 23137825
DOI: 10.1016/j.atherosclerosis.2012.10.041 -
Cureus Dec 2022Rheumatoid arthritis (RA) is an autoimmune condition in which the body's joints are attacked by the immune system, leaving the patient disabled in severe cases, with... (Review)
Review
Rheumatoid arthritis (RA) is an autoimmune condition in which the body's joints are attacked by the immune system, leaving the patient disabled in severe cases, with irreversible joint damage and a lower quality of life. RA patients are more likely to develop cardiovascular (CV) disease, which increases their risk of morbidity and mortality. This study systematically reviews various CV diseases that might occur with RA including heart failure (HF), coronary artery disease, acute coronary syndrome, ischemic heart disease, stroke, cardiac death, venous thromboembolism, and valvular diseases. The relation between these complications and RA is specifically assessed. Systematic search was carried out on literature reporting the risk of each of the CV diseases in RA patients from databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases searched were MEDLINE (through PubMed) and Google Scholar using a combination of keywords and medical subject headings (MeSH). Our keywords were mainly "cardiovascular diseases" and "arthritis and rheumatoid". We found a total of 33 articles reporting each CV comorbidity. Interestingly, a wide spectrum of CV diseases is reported in patients with RA. Many tools were implemented in the diagnosis of each disease such as carotid intima-media thickness for atherosclerosis and echocardiography for HF. We confirmed that RA is associated with an increased risk of different CV events, and prophylactic measures should be implemented.
PubMed: 36632250
DOI: 10.7759/cureus.32308